A recent meta-analysis has identified several clinical factors that may hinder the effectiveness of biologic therapies in treating psoriasis, according to findings published in JAMA Dermatology. Researchers analyzed data from 31 observational studies and nine randomized trials to explore associations between patient characteristics and treatment outcomes.
Key findings from the meta-analysis include:
- Previous Biologic Exposure: Patients with prior exposure to biologics were significantly less likely to achieve Psoriasis Area and Severity Index (PASI) 90 scores at 6 months (OR 0.44, 95% CI 0.29-0.67).
- Higher BMI: A higher body mass index (BMI) was negatively associated with treatment response, with an odds ratio of 0.96 (95% CI 0.94-0.99).
- Smoking History: Both previous (OR 0.81, 95% CI 0.67-0.98) and current smoking (OR 0.78, 95% CI 0.66-0.91) were linked to poorer treatment outcomes.
The analysis revealed that in randomized trials, only a BMI of 30 or higher showed a consistent negative association with achieving PASI 90 scores at 3 months (OR 0.57, 95% CI 0.48-0.66).
Lead author Christopher Willy Schwarz, MD, from Copenhagen University Hospital, highlighted previous research indicating that these factors, particularly previous biologic exposure, smoking, and higher BMI, are commonly associated with reduced biologic efficacy. However, conflicting evidence exists, and the impact of other factors such as sex on treatment response remains uncertain.
Schwarz noted the importance of tailored treatment strategies considering individual patient characteristics. “Patients who switch treatments due to adverse events or experience secondary biologic failure often achieve better responses with alternative therapies,” he explained.
Commenting on the findings, Danilo C. Del Campo, MD, emphasized the challenges in managing psoriasis cases that do not respond adequately to initial biologic treatments. “Optimal treatment selection, including consideration of BMI and smoking cessation, is crucial for improving outcomes,” Del Campo said.
Steven Daveluy, MD, highlighted potential mechanisms behind the reduced efficacy in patients with higher BMI, suggesting that adipose tissue contributes to systemic inflammation, which may interfere with treatment response.
The study, however, did not find evidence linking sex, diabetes, or psoriatic arthritis with treatment response. Shoshana Marmon, MD, PhD, stressed the need for further research to better understand these complexities.
Schwarz and colleagues acknowledged limitations, including the small number of studies available for subgroup analyses and variations in outcome measures across included studies. They recommended future research to explore differential effects of clinical characteristics on various biologics used in psoriasis treatment.
In conclusion, the meta-analysis underscores the multifactorial nature of psoriasis treatment response and advocates for personalized therapeutic approaches tailored to individual patient profiles beyond conventional considerations.
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